The blessing and curse of billing for massage services

Billing insurance companies for massage services has always been one of my mixed blessings throughout my career in massage. Right from the beginning of my career in 1989 with my little 250 hours of massage training, I have been able to bill auto insurance companies for car accidents and other insurance companies for slip and fall accidents. I didn’t need any extra training except for having to learn how to submit the bills and get paid. Through hit or miss and help from my friends, I learned the ropes. I say mixed blessing because that is exactly what it is for massage professionals. You will get new clients just by being on their list of providers. You will be able to create a successful practice billing insurance. You will have clients no matter what is going on with the economy because people get hurt and have health issues that massage can help. The difficulties are in some of the contracts you are required to sign will make you do things like take a client even if the company goes out of business and you won’t get paid at all and you have to do it for three months. Each year they also reduce their allowable fees- the amount that they will pay you. They also are constantly reducing the clients benefits and doing things like combining them with physical therapy. Then there are situations that arise that you have no control over like the recent transitioning of contracted providers from one company to another that has limited their enrollment of massage therapists and are opening up the list. Massage therapists are left scrambling to fill their schedules.

There still are some coverage issues and I only know of one plan that has preventative care. All the other plans require that massage be medically necessary and they do not cover maintenance massage. One of the other concerns here in WA when you are a provider is that many people just assume that they can get a massage and have their insurance pay for the massage. I am constantly telling people that it doesn’t cover you unless you have an injury or condition that massage can help. They don’t realize that we are the only state that pays for massage besides FL.

Here in WA we have been also able to bill major medical insurance companies like Aetna, Regence Blue Shield and Premera Blue cross as contracted providers. The history of being able to bill insurance companies here in WA is quite interesting and could be of assistance in other states who are wanting to be able to bill insurance by becoming contracted providers. Being a contracted provider requires that you go through a credentialing process with each insurance company or with the group that manages them. (American Whole Health manages the contracts for a few different companies like Aetna and Cigna here.) It is just a process of filling out forms, providing your experience, a few references and providing proof of your liability insurance. It does not currently require any additional training. I think you might have to have a few years of experience for one company.

The way it came about that massage therapists in WA could become contracted providers is because back in 1993, we had a very savvy insurance commissioner named Debra Senn who did like to get massage. It just so happened (not sure of the details on that part) that her massage therapist was also a very politically active massage therapist named Lori Belinski who used to lobby for the massage profession but now works for the chiropractic association. Together they created a law called the every category law that required insurance companies to accept massage therapists and other alternative health care providers such as acupuncturists as providers for insurance companies. It was made into law in 1995 and was supposed to go into effect in 1996 but the insurance companies filled law suits to tie it up in court until 1999 where the US Supreme Court made it into law. In Jan 2000 there was a report issues in coverage for complimentary and alternative medicine services which you can read part of online in this book on Google books.

So my theory is why are other states not following in the steps of WA State to get massage more accepted as a health care profession and get it to be covered on everyone’s insurance? We have the same basic 500 hour training required to become licensed as a massage therapist. Find your insurance commissioner in the list and start mailing them flyers to get a massage! Offer them free massages! Offer to come to their office and do free or low cost chair massage. Some think that it is going to take more research and evidence to make massage be part of the health care profession which may also mean more hours of training but WA is living proof that it isn’t needed. Yes, sure it could help. But what about a campaign to start working with the insurance commissioners? How about a campaign to write your insurance commissioners offices?

What other ideas do you have about how we could get the attention of the insurance companies and become contracted providers? What are you doing? What is your state doing? I think if we create more campaigns like this and get the whole profession involved, we could make it happen.

I still think it is a mixed blessing but I also do think it can help may of the struggling massage therapists and also help take make massage into a health care profession.

About Julie Onofrio

I just want to share what I know with you about building a massage business! Step by step : Websites, a referral network, ethics, self care and maybe a little insurance billing thrown in for fun! Thanks for reading!

Comments

Hi Julie; I’m in Washington too, and I am wondering what we can do collectively about the fact that several of the major plans in Washington aren’t going to cover massage at all anymore! We’ve taken a huge step backwards it would seem. Just wondering what your thoughts are on how we can stop this trend.

I don’t think it is a problem at all. That is just what comes with accepting ins. and being a contracted provider. You don’t really have any say in the matter. It isn’t a step backwards at all. I only know of one plan that is changing. Uniform is now using Regence to manage their plans -that is all. Is there another one? I say just focus on building your cash business and focus on building multiple streams of income.

Most defintely a blessing and a curse. I’ve billed auto and worker’s compensation claims for years with very little problem. I’ve even accepted liens against insurance settlements and eventually got paid (longest was 3 1/2 yrs). Of course, the attorney(s) wanted me to reduce my balance so that they and the client would receive more…..to which I firmly but politely said NO! In AZ, we’re not able to bill health insurance for massage services but at one time I shared an office with an osetopath who referred patients to me and billed insurance for treatment. Overall, I do very little insurance work anymore. While it can be lucrative, I find the additional paperwork, billing and hoping/praying for payment to be less than worth it. Thankfully, my schedule is very full with self-paying clients. I find these folks to be more committed to their health and willing to pay on their own. That being said, I wouldn’t completely shun insurance coverage for massage if it became available in AZ. I just wouldn’t want it to be my bread and butter.

I”ve had my own private practice for many years, but recently bought a massage studio and have commissioned therapists working at my place. The previous owner did not bill for several of my clients sessions before I took over, then when I asked about it, she sent them in. My question is two-fold, is it legal for her to bill since she no longer owns the company and two, I think she billed for consults, which a few therapists have told me is not a part of their billing practice. Is it considered fraud? I don’t want to get in trouble for something the previous owner did. I am in contact with the insurance company, but I don’t know if I have any recourse.

Thanks for sharing your experience with billing insurance for massage services. I have to agree with Allen Rubin’s statements in a previous post…clients who pay out of their own pockets have a vested interest in staying well. Clients who rely on insurance to pay for massage sessions don’t have a vested interest in staying well. I’ve been practicing for over 10 years independently (not in WA) and have never billed or wanted to bill insurance for my service. For over 6 years I worked out of an acupuncture wellness center in conjunction with an acupuncturist who billed insurance carriers. Yes, I got referrals from her, but the majority of these clients did nothing to help themselves get better–ie. exercise, quit smoking, lose weight, etc. With the majority of these referrals, I was feeding my healing energy into bottomless pits. Our healthcare system with insurance breeds complacency in many people. It’s my hope that massage therapists everywhere will stop seeking this avenue of compensation; it will eventually crimp the scope of practice for LMTs. And it simply doesn’t bring proactive, health-valuing individuals to your practice.